Injured kids: no insurance, no chance?

Florida children who are hospitalized without insurance are more that twice as likely to die there, a study shows.

By LISA GREENE
Published October 4, 2005

ST. PETERSBURG - Children stream into Florida hospitals every day after falling off bicycles or into swimming pools, being hurt in car wrecks or at the hands of a violent adult.

Whether they have insurance could in part foreshadow how well they will fare.

Children in Florida who enter the hospital without health insurance are more than twice as likely to die there as children with private health insurance or public insurance such as Medicaid, according to a new study by local researchers.

Of the nearly 11,000 children hospitalized in Florida with injuries in 2002, 131 died. About 18 percent of those deaths were uninsured patients, even though those patients made up only 8.5 percent of hospitalizations. Researchers released the findings Monday in a report produced by All Children's Hospital, the Florida Suncoast SAFE KIDS Coalition and USF Health.

Researchers weren't sure why but were concerned about the disparity and were applying for grant money to do another study.

"It begins to raise more questions than answer questions about how different children are injured," said pediatrician Dr. Lisa Simpson, who holds the All Children's Hospital Guild endowed chair in child health policy at the University of South Florida.

These children are most likely in families of the working poor - those whose parents make too little to afford private insurance but too much for the children to be covered by Medicaid. For now, researchers can only guess at disturbing possibilities:

--There might be something different about the way these children are hurt. Maybe they're in older cars that don't protect them as well in accidents. Maybe their places to play aren't as safe. Maybe they're more likely to be abused.

--Parents of children with insurance may be more willing to rush their child to the emergency room after an injury just in case, while parents without might wait longer to see if the child is seriously hurt or not have a car to drive to the hospital.

"You wonder, if it's something that's not quite so severe, whether, if you can't pay for it, you wait a little to go to the hospital, which is kind of sad," said Jean Lee, principal investigator of the study and a doctoral student at the USF College of Nursing.

--The children might be treated differently after they arrive at the hospital. Emergency rooms are required to treat patients regardless of whether they can pay, but studies have shown differences in outcomes for some medical conditions based on who has insurance, Simpson said.

Emergency doctors say they hope that's not the reason. It's hard to believe that's a factor for children with the most serious injuries, said Dr. Alan Causey, a pediatric emergency physician at All Children's Hospital in St. Petersburg.

"When a kid comes in that's a trauma alert, they don't come in with their parents," Causey said. "They come in by helicopter or by ambulance, and we don't know what their insurance is for a long time. It's an inadvertent lack of knowledge that's probably not a bad thing."

The data in the study included all children hospitalized in the state but not the most minor injuries - children treated and released - or the injuries so severe that children died before getting to the hospital.

The study found that children are more likely to die from different types of injuries at different ages. Children younger than age 1 are most likely to be killed deliberately by another person. Drowning is the most likely injury death for children ages 1 to 4. Children who are 5 or older are most likely to die in a car crash.

Children younger than 1 were most likely to die from their injuries. Those children made up 6.7 percent of hospitalizations but 16.8 percent of deaths.

Falls were the most frequent cause of injuries, but car wrecks caused the most deaths. Water accidents were especially dangerous. Near-drownings accounted for 2.4 percent of hospitalizations, but drownings were 11.5 percent of deaths.

Hospitals charged $194-million for children's hospitalizations because of injuries in Florida in 2002.

The study underscored the importance of injury prevention, Simpson said. Children should be strapped into car seats. Pools should be fenced and playgrounds cushioned.

"Many of these injuries are preventable," she said. "We need to invest in injury prevention."

More than $66-million of the hospital charges were billed to Medicaid and other children's health programs. More injury prevention would save tax dollars as well as lives, Simpson said.